Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Prescribing Pattern and Medication Inappropriateness in Geriatric Patients in a Tertiary Care Teaching Hospital

Background: Altered hepatic, renal and GIT function along with multiple comorbidities makes use of certaindrugs inappropriate in geriatric population. Identification and rectification of mistakes and lacunae in thecurrent prescribing pattern is crucial for ensuring appropriate and rational prescribing. Purpose: To study theprescribing pattern and medication inappropriateness in geriatric patients in a tertiary care teaching hospital.Material and Methods: Details of the prescribed drugs were obtained from the files of the 60 hospitalisedgeriatric patients and the prescribing pattern was studied. Medication inappropriateness was assessed and theinappropriate drugs were classified into various categories using Beers criteria given by American GeriatricSociety. Number of prescriptions having potential for drug interactions was also calculated. Results: Averagenumber of drugs per prescription was 7.7 with antibiotics being the most commonly prescribed drugs.49.13% were prescribed by brand names. 12.12% drugs were prescribed inappropriately and 20% prescriptionshad one or more inappropriate drug. Potential drug-drug interactions that should be avoided in older adultswere found in 11.6% prescriptions. Conclusion: A considerable fraction of the prescriptions of geriatricpatients were inappropriate and incidence of polypharmacy was very high. There is a pressing need to educatethe physicians about the mistakes in the prescribing pattern of geriatric patients and the adverse effect it canhave on the health of these patients.

Pharmacist intervention can reduce the potential use of inappropriate drugs medications in Indonesian geriatric patients

Intervention study design by pharmacists to doctors using face-to-face interviews conducted in this study aimsto analyze potentially inappropriate medications (PIMs) with prospective data collection in the geriatric ward ofRegional General Hospital Dr.M. M. Dunda Gorontalo, Indonesia in the period from January to March 2018. Thesampling technique was a total sampling design and obtained by the end of the study were 123 patients. Results ofanalysis with Beers and screening tool of older people’s prescriptions (STOPP) from 123 patients found 54 PIMs in48 patients (39.0%) based on Beers criteria and 6 patients (6.3%) based on STOPP criteria. Bivariate analysis showedthat there was a significant relationship between the incidence of adverse drug events (ADEs), with unresolved PIMswith a relative risk value at 1.55 (95% CI 1.26:1.91), p = 0.007 and a correlation coefficient (r) of 0.332. Based on theresults of univariate and bivariate statistical analysis, it can be concluded that there are still many PIMs occurring inthe prescription of geriatric patients based on Beers and STOPP criteria and pharmacists have a large enough role toreduce the incidence of PIMs so that the prevalence of ADEs due to inappropriate use of the drug can be minimized atRegional General Hospital Dr. M. M. Dunda Gorontalo, Indonesia.

Evaluation of Potentially Inappropriate Medication in Elderly Hospitalized Patients in Our Hospital Based on 2019 Beers Criteria / 中国药学杂志

OBJECTIVE: To investigate and analyze the potential inappropriate medication(PIM) in elderly hospitalized patients in our hospital, explore the related risk factors, and analyze the use of PIM involved drugs in different departments, so as to provide reference for the formulation of medication manuals for the elderies in different departments and for further standardizing the use of drugs in elderly patients. METHODS: The medical advice for elder patients(≥65 years old)hospitalised from January to October 2017 in our hospital was collected. Beers criteria of American Geriatrics Association 2019 was used as the reference to investigate and analyze PIM. And the risk factors of PIM were analyzed by logistic regression. RESULTS: The average age of 12 756 elderly hospitalized patients was (74.13±6.88) years and the average number of diseases per patient was (3.22±2.09). For each patient, (4.79±3.76) kinds of medicines were used. According to the 2019 Beers criteria, the incidence of PIM was 20.00%. Among them, the central nervous system medications(6.41%, 818/12 756) (estazolam tablets, alprazolam tablets) were the most frequently used. Data of PIM occurrence in different departments showed that the PIM incidence was higher in rheumatology, geriatrics, rehabilitation, anesthesia surgery and oncology departments. In addition, logistic regression analysis showed that gender, age, the number of combined medications and diseases, and length of stay were all potential risk factors for PIM. CONCLUSION: The incidence of PIM in elderly hospitalized patients in our hospital is high. The rational drug use in elderly patients needs to be improved.

Prevalência do uso de medicamentos potencialmente inapropriados ao idoso no Brasil: uma revisão sistemática / Prevalencia del uso de medicamentos potencialmente inapropiados para los ancianos en Brasil: una revisión sistemática / Prevalence use of potentially inappropriate drugs for elderly in Brazil: a sistematic review

O envelhecimento está relacionado, via de regra, ao uso de medicamentos. Esta é uma revisão sistemática sobre as prevalências de uso de medicamento potencialmente perigosos em idosos, em estudos brasileiros, utilizando-se o Critério de Beers. A prevalência variou entre 17 e 98,2% em amostras domiciliares, ambulatoriais, hospitalares e em instituições de longa permanência. Dados que demonstram a necessidade de políticas de enfrentamento aos riscos inerentes ao uso de medicamento pelo paciente idoso no Brasil.

The aging is related with use of drugs. This research is a systematic review about use of potentially inappropriate drugs for elderly evaluated by Beers Criteria. The prevalence's range was 17 to 98,2% on home, ambulatory, hospital or nursing home samples. These data demonstrate that governmental politics are necessary to face the risks of drugs using by elderly in Brazil.

El envejecimiento generalmente está relacionado con el uso de medicamentos. Esta es una revisión sistemática de la prevalencia del uso de drogas potencialmente peligrosas en los ancianos, en estudios brasileños, utilizando el Criterio de Beers. La prevalencia varió entre 17 y 98.2% en muestras de atención domiciliaria, ambulatoria, hospitalaria y de atención a largo plazo. Datos que demuestran la necesidad de políticas para enfrentar los riesgos inherentes al uso de medicamentos por parte de pacientes de edad avanzada en Brasil.

Analysis of prescription pattern of antihypertensive medication and adherence to Beers criteria in geriatric department of a tertiary care hospital in Mysuru

Background: The objective of the present study was to evaluate the prescription pattern of anti-hypertensive drugs and adherence to Beers’ criteria in geriatric department of JSS Hospital, Mysuru.Methods: An observational, prospective, cross-sectional study was carried out in geriatric department. The basic demographic information and prescriptions of geriatric patients were studied. Descriptive analysis was used to present the results, prescriptions were analysed and checked for adherence to Beers’ criteria.Results: Out of 485 patients, 82.68% received monotherapy, 15.87% received 2-drug combination therapy and 1.4% received 3-drug combination therapy. Among patients receiving monotherapy, angiotensin receptor blockers (49.06%) was the commonest antihypertensive class of drug prescribed. Telmisartan (38.96%) was the commonest drug prescribed. Among 2-drug combination therapy angiotensin converting enzyme inhibitor and Calcium channel blockers were combined commonly. In 3-drug combination therapy angiotensin converting enzyme inhibitor, beta blockers and diuretics were combined commonly. 99.3% of prescriptions were adhered to 2015 American Geriatrics Society Beers criteria.Conclusions: Almost 82% of the patients were treated with monotherapy. The trends in prescribing of anti-hypertensives were in favor of conventional ones such as Angiotensin receptor blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, diuretics, beta blockers and centrally acting alpha agonists. 99.3% of prescriptions were in accordance with the American Geriatrics Society 2015 Updated Beers criteria.

Comparison of Beers criteria and EU(7) potentially inappropriate medications list for the potentially inappropriate medications in Indian elderly inpatients

Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (?65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p<0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.

Potentially inappropriate prescribing in elderly: a comparison of Beers and STOPP criteria in tertiary care

Background: Prescribing in elderly is a challenging task as they have age related physiological changes, various co-morbidities, altered pharmacological properties and higher propensity for adverse events. They are often prescribed medications which are potentially inappropriate for them, sometimes may even be unnecessary. The medicines are considered as inappropriate if the risk associated with them outweighs benefits. The objective of this study is to assess the prevalence of potentially inappropriate medications (PIM) at a tertiary care teaching hospital according to the Beers updated 2015 criteria and STOPP criteria and to compare the two criteria in detection of PIMs.Methods: A prospective observational study involving 228 elderly patients (>65years) of medicine wards was conducted from October 2015 to March 2016. Relevant information was recorded in a predesigned proforma. The use of potentially inappropriate medications is assessed using Beers updated 2015 criteria and STOPP criteria using descriptive statistics.Results: The prevalence of PIM use in the sample was 26.31% according to the 2015 Beers criteria and 14.03% using the STOPP criteria. The most prevalent PIM according to the Beers criteria were sliding scale insulin (17.54%) and long acting benzodiazepines (5.26%); according to the STOPP criteria, they were aspirin in heart failure (5.26%) and chlorpheniramine (3.07%).Conclusions: The prevalence of PIM varied when different criteria were applied. The 2015 Beers criteria identified more PIM than the STOPP criteria.

Investigation of irrational drug use in elderly patients and analysis of influence factors of potentially inap-propriate medications andinfluence factors analysis of potential inappropriate medication in geriatric patients in senile people / 医学研究生学报

Objective The proportion of multiple drugs and the irrational use of drugs increased significantly in the elderly patients (over 80 years). This study aimed to investigate the occurrence of potentially inappropriate medication (PIM) and analyzed the possible reasons related to PIM in elderly patients. Methods In this study,918 cases from Cadre Ward I of Research Center for Geriatrics of Nanjing General Hospital of Nanjing Military Region were selected from January to December in 2016. According to the Beers Criteria (Version 2015),we evaluated PIM in four subtypes,type 1 that is not related to the state of disease in elderly patients, type 2 that is related to the state of disease in elderly patients,type 3 which should be used carefully,and type 4 which is the inappropriate combination of non-anti-infective Drugs. The PIM influence factors were analyzed by logistic regression analysis. Results There are 521 cases (56.75%) of type 1 PIM. The first 3 drugs are Short and medium acting benzodiazepams,PPI and long acting benzodiazepams. There are 206 cases (22.4%) of type 2 PIM. The first 2 drugs are drugs associated with insomnia (oral hyperemia, stimulants, theo-phylline and caffeine) and drugs associated with dementia or cognitive impairment (anti-cholinergic drugs and H2 receptor antago-nists). There are 834 cases (90.85%) of type 3 PIM,which should be used carefully and 45 cases(4.90%) of type 4 PIM.45 cases (4.90%) of non-anti-infective drugs should be avoid or reduced as much as possible in consideration of renal function. The number of combined drug use(OR=5.331,95% CI:3.549-8.009),the age(OR=1.171,95% CI:1.093-1.249),the Chalson's comorbidity index (OR=1.964,95% CI:1.477-2.450) are risk factors of PIM. Conclusion The incidence of potentially inappropriate use of drugs is high among the elderly patients. Reducing the number of combined drugs is an important measure to avoid the occurrence of PIM in elderly patients.

Interpretation of the list of alternative medications for high-risk medications in the elderly and potentially harmful drug-disease interactions based on the Beers criteria / 中华老年医学杂志

The National Committee for Quality Assurance(NCQA)and the Pharmacy Quality Alliance(PQA)used the American Geriatrics Society(AGS)Beers Criteria to establish the quality measure system of high-risk medications and potentially harmful drug-disease interactions in the elderly.Medications included may be harmful to elderly adults,and negatively affect health care plans' quality ratings.AGS experts conducted a comprehensive literature review and prepared a list of drug-therapy alternatives with supporting references.NCQA,PQA,the 2015 AGS Beers Criteria panel,and the Executive Committee of the AGS reviewed the drug therapy alternatives and nonpharmacological approaches.Prescribers,pharmacists,patients,and health care plans may benefit from this list.

Evaluation of the reliability of Beers criteria and medication appropriateness index in multimorbid elderly patients with polypharmacy / 中华老年医学杂志

Objective To evaluate and intervene polypharmacy in multimorbid elderly patients in order to explore the application effects and reliability of Beers criteria and medication appropriateness index(MAI)and improve the safety,rationality and feasibility of drug use through the whole process of pharmaceutical directions. Methods This study included 191 patients with multimorbidity.Based on the Beers criteria and MAI,enrolled elderly patients with multimorbidity were evaluated and intervened.Moreover,based on the efficacy,safety and suitability,clinical pharmacists and geriatricians made new medication strategy,and undertook a follow up study every month after discharge.After six months,all patients were evaluated again.All data were recorded before and 6-months after intervention. Results After versus before intervention,the potentially inappropriate polypharmacy was decreased[21 cases(10.99%)vs.98 cases(51.31%),χ2 = 65.154,P< 0.05]in multimorbid elderly patients.Moreover,the MAI score was significantly decreased after the intervention(6.35 ± 5.25 to 0.75 ± 1.81,Z= - 10.549,P< 0.05). Conclusions Through the whole process of pharmaceutical directions of clinical pharmacists,the Beers Criteria- and MAI-based assessment and intervention could improve the safety,rationality and efficiency of drug therapy in multimorbid elderly patients.

Analysis of clinical use of oral drugs in elderly geriatric inpatients / 中国医师进修杂志

Objective To analyze the inappropriate use of oral drugs in elderly patients admitted in internal medicine, and to guide clinical rational drugs use in elderly patients. Methods One hundred inpatients′ data over 65 years were collected in the department of geriatrics. The potentially inappropriate use of oral drug were analyzed according to the Beers criteria published in 2012 and drugs instructions. Results In 100 patients, (5.81 ± 2.78) kinds of oral drugs had been taken per inpatient. One patient was involved out-of-label usage. There were potentially inappropriate uses of oral drugs in 21 patients. Inappropriate use of oral drugs in three patients were not related to diagnosis or disease, and in 4 patients were related to morbid state, 14 patients used drugs that need to be used with caution in older adults. Conclusions There are off-label uses and potentially inappropriate medications in clinical practice, so clinical doctors should examine and assess the uses of drugs. Clinical doctors should strengthen the understanding and application of the comprehensive geriatric assessment.

Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases

ABSTRACT Management of pharmacotherapy in elderly with metabolic diseases is challenging and potentially inappropriate medications (PIMs) are risk factors for drug interactions and adverse events. The exposure to PIMs in elderly outpatients with metabolic diseases and its relationship with polypharmacy and other variables was investigated. PIMs prescribed to 207 elderly patients (aged 60 to 96 years) with metabolic diseases who attended a University Hospital of Sao Paulo city, Brazil, from April/2010 to January/2011, were evaluated. PIMs were detected using both 2003 Beers and 2008 STOPP criteria. The association between PIMs and age, gender and polypharmacy was also examined. 2008 STOPP criteria detected more PIMs (44.4 %) than 2003 Beers criteria (16.0%, p<0.001). Beers detected mainly PIMs antihypertensive (clonidine, 20.0%; doxazosin, 10.0%) and antidepressant (fluoxetine, 15.0%; amitriptyline, 10.0%) PIMs. Medicines used for cardiovascular (aspirin, 53.7%) and endocrine system (glibenclamide, 21.3%) were PIMs more frequently detected by 2008 STOPP. Unlike age and gender, polypharmacy increased the risk of PIMs by both 2003 Beers (OR: 4.0, CI95%: 1.2-13.8, p<0.031) and 2008 STOPP (OR: 6.8, CI95%: 3.0-15.3, p<0.001). Beers and STOPP criteria are important tools to evaluate the exposure to PIMs, which is strongly associated with polypharmacy in elderly outpatients with metabolic diseases.

Utilização de medicamentos potencialmente inapropriados por idosos em domicílio / Use of potentially inappropriate medications by the elderly at home

Resumo O objetivo foi avaliar a frequência de utilização em domicílio de medicamentos potencialmente inapropriados por idosos e analisar a significância clínica. Trata-se de estudo transversal retrospectivo, recorte de um estudo de utilização de medicamentos desenvolvido em um hospital público. Os medicamentos inapropriados foram classificados empregando os três grupos de critérios explícitos incluídos na Lista de Beers de 2012. Houve inclusão de 190 idosos na pesquisa e a prevalência encontrada para utilização de medicamentos inapropriados foi 44,2%. As classes terapêuticas de medicamentos inapropriados mais utilizados foram antiinflamatórios não esteroidais, agentes cardiovasculares, benzodiazepínicos e antidepressivos. Identificou-se associação positiva entre utilização de medicamentos inapropriados e polifarmácia, polipatologia e hipertensão. Na Rename 2013 identificou-se 35(34,3%) fármacos inapropriados. O estudo demonstrou alta prevalência de utilização de medicamentos inapropriados pelos idosos. As consequências clínicas da utilização de medicamentos inapropriados são importantes para a saúde pública devido ao risco de eventos adversos e impacto negativo na funcionalidade do idoso. Na atenção ao idoso é importante desenvolver ações para promover o uso racional de medicamentos.

Abstract The goal of this study was to assess how often potentially inappropriate medicines are used by the elderly at home, and analyze its clinical significance. This is a retrospective cross-sectional study, a segment of a study on the use of medication conducted at a public hospital. Inappropriate medication was classified according to the three criteria in the 2012 Beers List. 190 elderly were included in this study; the prevalence of the use of inappropriate medicines was 44.2%. The therapeutic classes of most often used inappropriate medicines were non-steroid anti-inflammatories, cardiovascular agents, benzodiazepines and antidepressants. We found a positive association between the use of inappropriate medicines and polypharmacy, polypathology and hypertension. The 2013 Rename identified 35 inappropriate drugs (34.3%). The study showed a high prevalence of using inappropriate medicines by the elderly. The clinical consequences of using inappropriate medicines are important for public health due to the risk of adverse events and a negative impact on elderly functionality. When it comes to caring for the elderly, it is important to develop measures to foster the rational use of medication.

Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors / 가정의학회지

BACKGROUND: Prescription of inappropriate medicine to elderly patients is a major public health care concern. The Beers criteria have been commonly employed as a screening tool to identify the use of potentially inappropriate medications (PIMs). The present study investigated the prevalence of PIM use according to the Beers criteria as well as factors related to PIM use. METHODS: Data obtained from a retrospective survey included 25,810 outpatients aged ≥65 years from a university medical center in Seoul, Korea. PIMs were defined using the Beers criteria. Factors associated with PIM use were evaluated using multiple regression analysis. RESULTS: Of all participants, 7,132 (27.6%) were prescribed at least one PIM. The most commonly prescribed PIMs were alprazolam (11.2%), clonazepam (10.8%), zolpidem (8.7%), quetiapine (8.4%), and hydroxyzine (5.4%). In multivariate logistic regression analysis, having five or more prescription medicines (odds ratio [OR], 11.32; 95% confidence interval [CI], 9.38 to 13.66) and five or more prescribing doctors (OR, 4.40; 95% CI, 3.59 to 5.39) were strongly associated with PIM. In a likelihood ratio test for trend, an increasing number of medications and prescribing doctors were both significantly associated with PIM. CONCLUSION: At a university medical center, the number of medications and the number of prescribing doctors was associated with PIM in older outpatients.

Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors / 가정의학회지

BACKGROUND: Prescription of inappropriate medicine to elderly patients is a major public health care concern. The Beers criteria have been commonly employed as a screening tool to identify the use of potentially inappropriate medications (PIMs). The present study investigated the prevalence of PIM use according to the Beers criteria as well as factors related to PIM use. METHODS: Data obtained from a retrospective survey included 25,810 outpatients aged ≥65 years from a university medical center in Seoul, Korea. PIMs were defined using the Beers criteria. Factors associated with PIM use were evaluated using multiple regression analysis. RESULTS: Of all participants, 7,132 (27.6%) were prescribed at least one PIM. The most commonly prescribed PIMs were alprazolam (11.2%), clonazepam (10.8%), zolpidem (8.7%), quetiapine (8.4%), and hydroxyzine (5.4%). In multivariate logistic regression analysis, having five or more prescription medicines (odds ratio [OR], 11.32; 95% confidence interval [CI], 9.38 to 13.66) and five or more prescribing doctors (OR, 4.40; 95% CI, 3.59 to 5.39) were strongly associated with PIM. In a likelihood ratio test for trend, an increasing number of medications and prescribing doctors were both significantly associated with PIM. CONCLUSION: At a university medical center, the number of medications and the number of prescribing doctors was associated with PIM in older outpatients.

Evaluation of Potentially Inappropriate Medication among Elderly Inpatients in Internal Medicine Depart-ment of Our Hospital by Beers Criteria and STOPP/START Criteria / 中国药房

OBJECTIVE:To improve rational drug use and reduce potentially inappropriate medication (PIM). METHODS:PIM of 700 elderly inpatients in internal medicine department of our hospital was evaluated by Beers criteria(2012 edition)and STOPP/START criteria. RESULTS:700 inpatients whose mean ages were (76.3 ± 7.2) years old took (12.1 ± 4.9) kinds of drugs per patient. 144 cases involved PIM(20.6%). The number of PIM was 220 in total,among which there were 117 cases/times relat-ed to drugs and 22 cases/times related to disease in according to Beers criteria,9 cases/times of STOPP and 72 cases/times of START. Drug with most frequency of PIM in accordance with Beers was benzodiazepines and most frequency in STOPP was thia-zides that used by patients with gout histonry. The most omission frequency of START prescription were absence of metformin thera-py for type 2 diabetes and absence of antiplatelet therapy for diabetes complicated with cardiovascular risk. CONCLUSIONS:A high prevalence of PIM in elderly inpatients in our hospital requires various measures to prevent its occurrence.

Effects of polypharmacy assessment and intervention on the elderly inpatients / 中国医师进修杂志

Objective To explore the effect of polypharmacy assessment and intervention on elderly inpatients mainly in both economy and safety. Methods One hundred and forty elderly inpatients were selected. Fifty patients took less than 5 drugs, 75 patients took 5- 9 drugs, and 15 patients took more than 10 drugs. According to medication appropriateness index (MAI) and Beers criteria, the polypharmacy of elderly inpatients was assessed and intervened. The results were compared before and after intervention. Results The discrepancy rate of Beers criteria, incidence of potential risk, total scores of prescription MAI and average daily drug cost after intervention were significantly lower than that before intervention: 7.14% (10/140) vs. 16.43% (23/140), 22.14% (31/140) vs. 90.71%(127/140), 0(0,0)scores vs. 6.00(2.25,10.00)scores and (30.60 ± 19.71) yuan vs. (35.34 ± 26.84) yuan, and there were statistical differences (P<0.01 or <0.05). Conclusions Irregular medication exists widely in elderly patients, and the polypharmacy assessment and intervention can lighten the financial burden of elderly patients and improve the safety of drug therapy.

Potentially inappropriate medication use among Brazilian elderly in a medication management program / Uso de medicamentos potencialmente inapropriado em idosos brasileiros em um programa de gerenciamento de medicamento

A descriptive, cross-sectional study of data from 15 elderly users of the Medication Therapy Management (MTM) service, delivered as a university extension project at a primary health unit in the city of Minas Gerais, Brazil was carried out. The objective of the study was to assess the use of potentially inappropriate medication (PIM) according to the Beers criteria (2015 version) and its relationship with drug-related problems (DRPs) identifed both theoretically and by the students during the process of service provision. The MTM service adopted the methodology recommended in the theoretical framework of Pharmaceutical Care Practice. In addition, the knowledge on PIMs held by the Pharmacy students involved in the service was assessed by applying a semi-structured questionnaire. The majority of the patient population was in use of at least one PIM (60%), with a total of 10 PIMs prescribed to 9 patients. Each PIM corresponded to a single DRP (n=10). However, the Pharmacy students providing the service identifed only three DRPs. All of the students interviewed reported knowing the PIM concept. However, the majority of students were unable to identify the PIMs in the pharmacotherapy of their patients. These results highlight the importance of the Beers criteria for identifying DRPs and the need for greater focus on these criteria during Pharmacy training.(AU)

Este estudo transversal descritivo foi realizado com dados de 15 idosos acompanhados em um Serviço de Gerenciamento da Terapia Medicamentosa ofertado como projeto de extensão universitária em uma unidade de atenção primária à saúde em um município de Minas Gerais, Brasil. Teve como objetivo avaliar a utilização de medicamentos potencialmente inadequados (MPI) de acordo com os critérios de Beers (versão 2015) e sua relação com problemas relacionados ao uso de medicamentos (PRM) identifcados teoricamente bem como aqueles identifcados pelos estudantes durante o processo de provisão do serviço. O serviço seguiu a metodologia preconizada no arcabouço teórico de Pharmaceutical Care Practice. Além disso, por meio de um questionário semiestruturados, foi avaliado o conhecimento dos estudantes de Farmácia envolvidos no serviço acerca de MPI. A maioria da população utilizava pelo menos um MPI (60%), sendo que foram identifcados 10 MPI que estavam prescritos para 9 idosos. Cada MPI correspondeu a um PRM teórico (n=10). No entanto, os estudantes de Farmácia oferecendo o serviço identifcaram apenas três PRM. Todos os estudantes entrevistados relataram conhecer o conceito de MPI. Porém, a maioria não os identifcou na farmacoterapia de seus pacientes. Estes resultados demonstram a importância dos critérios de Beers para identifcação de PRM e a necessidade de melhorias na sua abordagem durante a graduação em Farmácia.(AU)

Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: a prospective study from a tertiary care hospital.

Background: To investigate the prevalence of potentially inappropriate medications (PIMs) using updated Beers criteria 2012 and drug utilization study among the elderly patients attending the various outpatient departments (OPDs) of a tertiary care hospital at Pondicherry in India. Methods: This prospective, observational study involving patients aged 65 years and above, was planned and conducted over a period of six months, who attended the various OPDs were included in the study. Prescriptions were collected from the consulting rooms and pharmacy. Results: A total of 600 patients aged 65 years and above were involved in our study. Majority (61.83%) were in the age group of 65-70 years. There was a male preponderance (61.83%). Total of 1769 drugs were prescribed, giving an average of 2.98 drugs per person (range 1 to 9). Polypharmacy (≥ 5drugs) were observed in 99 patients. Of the total 748 disease conditions, cardiovascular diseases were the most prevalent (29.33%) among the elderly patients. Almost 114 patients had comorbid conditions. General medicine department was the highest (28.83%) visited patients. Frequently prescribed drugs belong to the category of analgesic and anti-inflammatory agents (16.50%). Fixed Dose Combination (FDC) was 31%. Almost 110 patients received PIMs from Beers list; majority were belonging to category 1. NSAIDs (30.66%) were the highest PIMs prescribed to musculoskeletal disorders. With regard to WHO indicator, 377(21.31%) drugs were prescribed by generic name. Utilization from Indian national list of essential medicine was 76.82%. Percentage of encounters in which an antibiotic and injections was prescribed to 23.5% and 26.33% respectively. Conclusions: Study has shown the prevalence of disease pattern, comorbidity, drug usage in elderly. PIMs, polypharmacy and FDC were high among the elderly. Prescribers need to be educated about Beers criteria and encouraged for rational prescription.